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Qu Q, Liu Z, Lu M, Xu L, Zhang J, Liu M, Jiang J, Gu C, Ma Q, Huang A, Zhang X, Zhang T. Preoperative Gadoxetic Acid-Enhanced MRI Features for Evaluation of Vessels Encapsulating Tumor Clusters and Microvascular Invasion in Hepatocellular Carcinoma: Creating Nomograms for Risk Assessment. J Magn Reson Imaging 2024; 60:1094-1110. [PMID: 38116997 DOI: 10.1002/jmri.29187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Vessels encapsulating tumor cluster (VETC) and microvascular invasion (MVI) have a synergistic effect on prognosis assessment and treatment selection of hepatocellular carcinoma (HCC). Preoperative noninvasive evaluation of VETC and MVI is important. PURPOSE To explore the diagnosis value of preoperative gadoxetic acid (GA)-enhanced magnetic resonance imaging (MRI) features for MVI, VETC, and recurrence-free survival (RFS) in HCC. STUDY TYPE Retrospective. POPULATION 240 post-surgery patients with 274 pathologically confirmed HCC (allocated to training and validation cohorts with a 7:3 ratio) and available tumor marker data from August 2014 to December 2021. FIELD STRENGTH/SEQUENCE 3-T, T1-, T2-, diffusion-weighted imaging, in/out-phase imaging, and dynamic contrast-enhanced imaging. ASSESSMENT Three radiologists subjectively reviewed preoperative MRI, evaluated clinical and conventional imaging features associated with MVI+, VETC+, and MVI+/VETC+ HCC. Regression-based nomograms were developed for HCC in the training cohort. Based on the nomograms, the RFS prognostic stratification system was further. Follow-up occurred every 3-6 months. STATISTICAL TESTS Chi-squared test or Fisher's exact test, Mann-Whitney U-test or t-test, least absolute shrinkage and selection operator-penalized, multivariable logistic regression analyses, receiver operating characteristic analysis, Harrell's concordance index (C-index), Kaplan-Meier plots. Significance level: P < 0.05. RESULTS In the training group, 44 patients with MVI+ and 74 patients with VETC+ were histologically confirmed. Three nomograms showed good performance in the training (C-indices: MVI+ vs. VETC+ vs. MVI+/VETC+, 0.892 vs. 0.848 vs. 0.910) and validation (C-indices: MVI+ vs. VETC+ vs. MVI+/VETC+, 0.839 vs. 0.810 vs. 0.855) cohorts. The median follow-up duration for the training cohort was 43.6 (95% CI, 35.0-52.2) months and 25.8 (95% CI, 16.1-35.6) months for the validation cohort. Patients with either pathologically confirmed or nomogram-estimated MVI, VETC, and MVI+/VETC+ suffered higher risk of recurrence. DATA CONCLUSION GA-enhanced MRI and clinical variables might assist in preoperative estimation of MVI, VETC, and MVI+/VETC+ in HCC. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Qi Qu
- Nantong University, Nantong, Jiangsu, China
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Zixin Liu
- Nantong University, Nantong, Jiangsu, China
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Mengtian Lu
- Nantong University, Nantong, Jiangsu, China
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Lei Xu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Jiyun Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Maotong Liu
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Jifeng Jiang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Chunyan Gu
- Department of Pathology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Qinrong Ma
- Department of Pathology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Aina Huang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Xueqin Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
| | - Tao Zhang
- Department of Radiology, Affiliated Nantong Hospital 3 of Nantong University, Nantong Third People's Hospital, Nantong, Jiangsu, China
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Fukushima R, Harimoto N, Okuyama T, Seki T, Hoshino K, Hagiwara K, Kawai S, Ishii N, Tsukagoshi M, Igarashi T, Araki K, Tomonaga H, Higuchi T, Shimokawa M, Shirabe K. New predictors of microvascular invasion for small hepatocellular carcinoma ≤ 3 cm. Int J Clin Oncol 2024; 29:1182-1190. [PMID: 38769190 DOI: 10.1007/s10147-024-02553-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Microvascular invasion (MVI) is a risk factor for postoperative recurrence of hepatocellular carcinoma (HCC), even in early-stage HCC. In small HCC ≤ 3 cm, treatment options include anatomical resection or non-anatomical resection, and MVI has a major effect on treatment decisions. We aimed to identify the predictors of MVI in small HCC ≤ 3 cm. METHODS We retrospectively studied 129 patients with very early or early-stage HCC ≤ 3 cm who had undergone 18F-fluorodeoxyglucose positron emission tomography/computed tomography and subsequent hepatic resection from January 2016 to August 2023. These patients were divided into the derivation cohort (n = 86) and validation cohort (n = 43). We examined the risk factors for MVI using logistic regression analysis, and established a predictive scoring system in the derivation cohort. We evaluated the accuracy of our scoring system in the validation cohort. RESULTS In the derivation cohort, a Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3), prothrombin induced by vitamin K deficiency or antagonist-II (PIVKA-II), and metabolic tumor volume (MTV) were independent predictors of MVI. We established the scoring system using these three factors. In the validation test, there were no MVI-positive cases with a score of 0 and 1, and all cases were MVI-positive with a score of 4. Moreover, with a score ≥ 2, the sensitivity, specificity, and accuracy of our scoring system were 100%, 71.4%, and 81.4%, respectively. CONCLUSIONS Our scoring system can accurately predict MVI in small HCC ≤ 3 cm, and could contribute to establishing an appropriate treatment strategy.
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Affiliation(s)
- Ryosuke Fukushima
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan.
| | - Takayuki Okuyama
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Takaomi Seki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Kouki Hoshino
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Kei Hagiwara
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Shunsuke Kawai
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Takamichi Igarashi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Hiroyasu Tomonaga
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showamachi, Maebashi, Japan
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Qiao W, Xiong Y, Li K, Jin R, Zhang Y. Incorporating Inflammatory Markers and Clinical Indicators into a Predictive Model of Single Small Hepatocellular Carcinoma Recurrence After Primary Locoregional Treatments. J Hepatocell Carcinoma 2024; 11:1113-1125. [PMID: 38887683 PMCID: PMC11182039 DOI: 10.2147/jhc.s465069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
Purpose We explored the role of tumor size and number in the prognosis of HCC patients who underwent ablation and created a nomogram based on machine learning to predict the recurrence. Patients and Methods A total of 990 HCC patients who underwent transcatheter arterial chemoembolization (TACE) combined ablation at Beijing Youan Hospital from January 2014 to December 2021 were prospectively enrolled, including 478 patients with single small HCC (S-S), 209 patients with single large (≥30mm) HCC (S-L), 182 patients with multiple small HCC (M-S), and 121 patients with multiple large HCC (M-L). S-S patients were randomized in a 7:3 ratio into the training cohort (N=334) and the validation cohort (N=144). Lasso-Cox regression analysis was carried out to identify independent risk factors, which were used to construct a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves. Patients in the training and validation cohorts were divided into low-risk, intermediate-risk, and high-risk groups based on the risk scores of the nomogram. Results The median recurrence-free survival (mRFS) in S-S patients was significantly longer than the S-L, M-S, and S-L patients (P<0.0001). The content of the nomogram includes age, monocyte-to-lymphocyte (MLR), gamma-glutamyl transferase-to-lymphocyte (GLR), International normalized ratio (INR), and Erythrocyte (RBC). The C-index (0.704 and 0.71) and 1-, 3-, and 5-year AUCs (0.726, 0.800, 0.780, and 0.752, 0.761, 0.760) of the training and validation cohorts proved the excellent predictive performance of the nomogram. Calibration curves the DCA curves showed that the nomogram had good consistency and clinical utility. There were apparent variances in RFS between the low-risk, intermediate-risk, and high-risk groups (P<0.0001). Conclusion S-S patients who underwent ablation had the best prognosis. The nomogram developed and validated in the study had good predictive ability for S-S patients.
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Affiliation(s)
- Wenying Qiao
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Changping Laboratory, Beijing, 102206, People’s Republic of China
| | - Yiqi Xiong
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Kang Li
- Research Center for Biomedical Resources, Beijing You’an Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Ronghua Jin
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
- Changping Laboratory, Beijing, 102206, People’s Republic of China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
- Beijing Research Center for Respiratory Infectious Diseases, Beijing, 100006, People’s Republic of China
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Dong B, Zhang H, Duan Y, Yao S, Chen Y, Zhang C. Development of a machine learning-based model to predict prognosis of alpha-fetoprotein-positive hepatocellular carcinoma. J Transl Med 2024; 22:455. [PMID: 38741163 PMCID: PMC11092049 DOI: 10.1186/s12967-024-05203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Patients with alpha-fetoprotein (AFP)-positive hepatocellular carcinoma (HCC) have aggressive biological behavior and poor prognosis. Therefore, survival time is one of the greatest concerns for patients with AFP-positive HCC. This study aimed to demonstrate the utilization of six machine learning (ML)-based prognostic models to predict overall survival of patients with AFP-positive HCC. METHODS Data on patients with AFP-positive HCC were extracted from the Surveillance, Epidemiology, and End Results database. Six ML algorithms (extreme gradient boosting [XGBoost], logistic regression [LR], support vector machine [SVM], random forest [RF], K-nearest neighbor [KNN], and decision tree [ID3]) were used to develop the prognostic models of patients with AFP-positive HCC at one year, three years, and five years. Area under the receiver operating characteristic curve (AUC), confusion matrix, calibration curves, and decision curve analysis (DCA) were used to evaluate the model. RESULTS A total of 2,038 patients with AFP-positive HCC were included for analysis. The 1-, 3-, and 5-year overall survival rates were 60.7%, 28.9%, and 14.3%, respectively. Seventeen features regarding demographics and clinicopathology were included in six ML algorithms to generate a prognostic model. The XGBoost model showed the best performance in predicting survival at 1-year (train set: AUC = 0.771; test set: AUC = 0.782), 3-year (train set: AUC = 0.763; test set: AUC = 0.749) and 5-year (train set: AUC = 0.807; test set: AUC = 0.740). Furthermore, for 1-, 3-, and 5-year survival prediction, the accuracy in the training and test sets was 0.709 and 0.726, 0.721 and 0.726, and 0.778 and 0.784 for the XGBoost model, respectively. Calibration curves and DCA exhibited good predictive performance as well. CONCLUSIONS The XGBoost model exhibited good predictive performance, which may provide physicians with an effective tool for early medical intervention and improve the survival of patients.
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Affiliation(s)
- Bingtian Dong
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua Zhang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Yayang Duan
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Senbang Yao
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Department of Oncology, Anhui Medical University, Hefei, Anhui, China
| | - Yongjian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
| | - Chaoxue Zhang
- Department of Ultrasound, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Xiong Y, Zhang Y, Hu C. Radiofrequency ablation versus microwave ablation for hepatocellular carcinoma with cirrhosis: a propensity score analysis. Transl Cancer Res 2024; 13:1807-1820. [PMID: 38737685 PMCID: PMC11082659 DOI: 10.21037/tcr-23-1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/22/2024] [Indexed: 05/14/2024]
Abstract
Background Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most frequently used percutaneous ablation techniques for the treatment of liver cancer. The aim of our study was to identify the ablation method that had a better long-term prognosis for patients with cirrhotic hepatocellular carcinoma (HCC). Methods This retrospective study consisted of HCC patients with cirrhosis who underwent RFA and MWA between January 2014 to December 2021 at Beijing You'an Hospital. Patients were divided into two groups according to the therapeutic approaches: the RFA group and the MWA group. The prognosis was compared before and after 1:1 propensity score matching (PSM). Results A total of 800 HCC patients with cirrhosis who received interventional treatment from January 2014 to December 2021 were prospectively enrolled. After PSM, there were 268 patients in each of the RFA and MWA groups. The statistically significant differences in recurrence-free survival (RFS) and overall survival (OS) between RFA and MWA groups can be observed, both before and after PSM. Besides, 1-, 3-year RFS, and 5-year OS rates were higher in those the RFA group than in the MWA group. Age, tumor size, gamma glutamyl transferase (GGT), and hepatitis B surface antigen (HBsAg) were independent risk factors for RFS. Child-Pugh, lymphocyte (Lym), GGT, and treatment modality were independent risk factors for OS. Conclusions For patients with HCC associated with cirrhosis, RFA can provide a better prognosis than MWA, with lower recurrence and mortality rate.
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Affiliation(s)
- Yiqi Xiong
- Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Caixia Hu
- Interventional Therapy Center for Oncology, Beijing You'an Hospital, Capital Medical University, Beijing, China
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He Q, Xiong Y, Xia P, Yang X, Yu Y, Chen Z. Predicting cancer-specific mortality in T1/2 hepatocellular carcinoma after radiofrequency ablation by competing risk nomogram: A population-based analysis. Clin Res Hepatol Gastroenterol 2024; 48:102283. [PMID: 38219821 DOI: 10.1016/j.clinre.2024.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the primary treatment methods for T1/2 hepatocellular carcinoma (HCC), but the risk factors after RFA remain controversial. This study aims to identify the key factors associated with cancer-specific mortality (CSM) in patients with T1/2 HCC after RFA using competing risk analysis and to establish a prognostic nomogram for improved clinical management. METHODS A total of 2,135 T1/2 HCC patients treated with RFA were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and randomly categorized into training and validation sets. Univariate and multivariable competing risk analyses were performed to identify risk factors associated with CSM and construct a competing risk nomogram. Receiver operating characteristic (ROC) curves, concordance indices (C-indexes), calibration plots, and decision curve analysis (DCA) were conducted to evaluate the predictive efficiency and clinical applicability of the nomogram in the training and validation sets. Patients were stratified according to their nomogram score, and the different risk groups were compared using cumulative incidence function (CIF) curves and Gray's validation . RESULTS The 5-year CSM rate for HCC patients treated with RFA was 30.1 %. Grade, tumor size, tumor number, cirrhosis, and AFP level were identified as independent risk factors for CSM. A prognostic nomogram was developed based on these risk factors. The time-dependent C-indexes (0.65) were greater than those of the AJCC stage model (0.55) during the 12 to 60 months of follow-up. The calibration plots of the competing risk nomograms demonstrated excellent consistency between actual survival and nomogram predictions. ROC analyses showed that the 1-, 3-, and 5-year AUC values in both the training and validation cohorts were all greater than 0.63 and exceeded those of the AJCC stage model. DCA demonstrated the clinical usefulness of the nomogram. Patients were classified into low-, moderate-, and high-risk groups based on the nomogram scores, with the high-risk group showing significantly higher CSM rates after RFA compared to the other two groups. CONCLUSIONS We identified Grade, AFP, cirrhosis, tumor size, and tumor number as independent risk factors associated with CSM. The competing risk nomogram exhibited high performance in predicting the probability of CSM for HCC patients undergoing RFA.
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Affiliation(s)
- Qifan He
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yue Xiong
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Pengcheng Xia
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Xiaoyu Yang
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Yihui Yu
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China
| | - Zhonghua Chen
- Department of Radiology, Haining People's Hospital, Jiaxing, Zhejiang, China.
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Minamiguchi K, Irizato M, Uchiyama T, Taiji R, Nishiofuku H, Marugami N, Tanaka T. Hepatobiliary-phase gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid MRI for pretreatment prediction of efficacy-to-standard-therapies based on Barcelona Clinic Liver Cancer algorithm: an up-to-date review. Eur Radiol 2023; 33:8764-8775. [PMID: 37470828 DOI: 10.1007/s00330-023-09950-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/15/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023]
Abstract
Recent advances in systemic therapy have had major impacts on treatment strategies for hepatocellular carcinoma (HCC). The 2022 Barcelona Clinic Liver Cancer (BCLC) guidelines incorporate a new section on clinical decision-making for personalized medicine, although the first treatment suggested by the BCLC guidelines is based on solid scientific evidence. More than ever before, the appropriate treatment strategy must be selected prior to the initiation of therapy for HCC. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA-MRI) is essential for liver imaging and the hepatobiliary phase (HBP) of EOB-MRI reflects the expression of organic anion transporting polypeptide (OATP) transporters. Molecules associated with OATP expression are relevant in the molecular classification of HCC subclasses, and EOB-MRI is becoming increasingly important with advances in the molecular and genetic understanding of HCC. In this review, we describe imaging findings for the pretreatment prediction of response to standard therapies for HCC based on the BCLC algorithm using the HBP of EOB-MRI, with specific attention to the molecular background of OATPs. A more complete understanding of these findings will help radiologists suggest appropriate treatments and clinical follow-ups and could lead to the development of more personalized treatment strategies in the future. CLINICAL RELEVANCE STATEMENT: In the coming era of personalized medicine, HBP of EOB-MRI reflecting molecular and pathological factors could play a predictive role in the therapeutic efficacy of HCC and contribute to treatment selection. KEY POINTS: • Imaging features of hepatobiliary phase predict treatment efficacy prior to therapy and contribute to treatment choice. • Wnt/β-catenin activation associated with organic anion transporting polypeptide expression is involved in the tumor immune microenvironment and chemo-responsiveness. • Peritumoral hypointensity of hepatobiliary phase reflecting microvascular invasion affects the therapeutic efficacy of locoregional to systemic therapy.
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Affiliation(s)
- Kiyoyuki Minamiguchi
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan.
| | - Mariko Irizato
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Ryosuke Taiji
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan
| | - Hideyuki Nishiofuku
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan
| | - Nagaaki Marugami
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Shijyocho 840, Kashihara, Nara, 634-8522, Japan
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Zhan G, Cao P, Peng H. Construction of web -based prediction nomogram models for cancer -specific survival in patients at stage IV of hepatocellular carcinoma depending on SEER database. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1546-1560. [PMID: 38432884 PMCID: PMC10929905 DOI: 10.11817/j.issn.1672-7347.2023.230040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) prognosis involves multiple clinical factors. Although nomogram models targeting various clinical factors have been reported in early and locally advanced HCC, there are currently few studies on complete and effective prognostic nomogram models for stage IV HCC patients. This study aims to creat nomograms for cancer-specific survival (CSS) in patients at stage IV of HCC and developing a web predictive nomogram model to predict patient prognosis and guide individualized treatment. METHODS Clinicopathological information on stage IV of HCC between January, 2010 and December, 2015 was collected from the Surveillance, Epidemiology, and End Results (SEER) database. The patients at stage IV of HCC were categorized into IVA (without distant metastases) and IVB (with distant metastases) subgroups based on the presence of distant metastasis, and then the patients from both IVA and IVB subgroups were randomly divided into the training and validation cohorts in a 7꞉3 ratio. Univariate and multivariate Cox regression analyses were used to analyze the independent risk factors that significantly affected CSS in the training cohort, and constructed nomogram models separately for stage IVA and stage IVB patients based on relevant independent risk factors. Two nomogram's accuracy and discrimination were evaluated by receiver operator characteristic (ROC) curves and calibration curves. Furthermore, web-based nomogram models were developed specifically for stage IVA and stage IVB HCC patients by R software. A decision analysis curve (DCA) was used to evaluate the clinical utility of the web-based nomogram models. RESULTS A total of 3 060 patients were included in this study, of which 883 were in stage IVA, and 2 177 were in stage IVB. Based on multivariate analysis results, tumor size, alpha-fetoprotein (AFP), T stage, histological grade, surgery, radiotherapy, and chemotherapy were independent prognostic factors for patients with stage IVA of HCC; and tumor size, AFP, T stage, N stage, histological grade, lung metastasis, surgery, radiotherapy, and chemotherapy were independent prognostic factors for patients with stage IVB HCC. In stage IVA patients, the 3-, 6-, 9-, 12-, 15-, and 18-month areas under the ROC curves for the training cohort were 0.823, 0.800, 0.772, 0.784, 0.784, and 0.786, respectively; and the 3-, 6-, 9-, 12-, 15-, and 18-month areas under the ROC curves for the validation cohort were 0.793, 0.764, 0.739, 0.773, 0.798, and 0.799, respectively. In stage IVB patients, the 3-, 6-, 9-, and 12-month areas under the ROC curves for the training cohort were 0.756, 0.750, 0.755, and 0.743, respectively; and the 3-, 6-, 9-, and 12-month areas under the ROC curves for the validation cohort were 0.744, 0.747, 0.775, and 0.779, respectively; showing that the nomograms had an excellent predictive ability. The calibration curves showed a good consistency between the predictions and actual observations. CONCLUSIONS Predictive nomogram models for CSS in stage IVA and IVB HCC patients are developed and validated based on the SEER database, which might be used for clinicians to predict the prognosis, implement individualized treatment, and follow up those patients.
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Affiliation(s)
- Gouling Zhan
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Peiguo Cao
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
| | - Honghua Peng
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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Sun Y, Xiong Y, Wang Q, Qiao W, Zhang H, Zhang Y. Development and validation of a nomogram to predict the recurrence of hepatocellular carcinoma patients with dynamic changes in AFP undergoing locoregional treatments. Front Oncol 2023; 13:1206345. [PMID: 37700838 PMCID: PMC10494718 DOI: 10.3389/fonc.2023.1206345] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Serum alpha-fetoprotein (AFP) is an important clinical indicator for screening, diagnosis, and prognosis of primary hepatocellular carcinoma (HCC). Our team's previous study showed that patients with negative AFP at baseline and positive AFP at relapse had a worse prognosis (N-P). Therefore, the aim of our study was to develop and validate a nomogram for this group of patients. Methods A total of 513 patients with HCC who received locoregional treatments at Beijing You'an Hospital, Capital Medical University, from January 2012 to December 2019 were prospectively enrolled. Patients admitted from 2012 to 2015 were assigned to the training cohort (n = 335), while 2016 to 2019 were in the validation cohort (n =183). The clinical and pathological features of patients were collected, and independent risk factors were identified using univariate and multivariate Cox regression analysis as a basis for developing a nomogram. The performance of the nomogram was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) curves in the training and validation cohorts. Results The content of the nomogram includes gender, tumor number, tumor size, lymphocyte, direct bilirubin (DBIL), gamma-glutamyl transferase (GGT), and prealbumin. The C-index (0.717 and 0.752) and 1-, 3-, and 5-year AUCs (0.721, 0.825, 0.845, and 0.740, 0.868, 0.837) of the training and validation cohorts proved the good predictive performance of the nomogram. Calibration curves and DCA curves suggested accuracy and net clinical benefit rates. The nomogram enabled to classify of patients with dynamic changes in AFP into three groups according to the risk of recurrence: low risk, intermediate risk, and high risk. There was a statistically significant difference in RFS between the three groups in the training and validation cohorts (P<0.001). Conclusion The nomogram developed and validated in this study had good predictive power for patients with dynamic changes in AFP.
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Affiliation(s)
- Yu Sun
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yiqi Xiong
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Qi Wang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Wenying Qiao
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Honghai Zhang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Interventional Therapy Center for Oncology, Beijing You’an Hospital, Capital Medical University, Beijing, China
- Research Center for Biomedical Resources, Beijing You’an Hospital, Capital Medical University, Beijing, China
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Wang Z, Qin H, Liu S, Sheng J, Zhang X. Precision diagnosis of hepatocellular carcinoma. Chin Med J (Engl) 2023; 136:1155-1165. [PMID: 36939276 PMCID: PMC10278703 DOI: 10.1097/cm9.0000000000002641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Indexed: 03/21/2023] Open
Abstract
ABSTRACT Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.
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Affiliation(s)
- Zhenxiao Wang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Hanjiao Qin
- Department of Radiotherapy, Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Shui Liu
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Jiyao Sheng
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Xuewen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Second Hospital of Jilin University, Changchun, Jilin 130041, China
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Wu ZQ, Cheng J, Xiao XX, Zhang HR, Wang J, Peng J, Liu C, Cai P, Li XM. Preoperative prediction of early recurrence of HBV-related hepatocellular carcinoma (≤5 cm) by visceral adipose tissue index. Front Surg 2023; 9:985168. [PMID: 36684155 PMCID: PMC9852492 DOI: 10.3389/fsurg.2022.985168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/04/2022] [Indexed: 01/09/2023] Open
Abstract
Background This study aimed to investigate whether visceral adipose tissue index (VATI) is a significant risk factor for the early recurrence (ER) of HBV-related hepatocellular carcinoma (HCC) (≤5 cm) after hepatectomy. Methods The recruited cohort patients who were positive for hepatitis B virus, presented with surgically confirmed HCC (≤5 cm) from Army Medical University (internal training cohort: n = 192) and Chongqing Medical University (external validation group: n = 46). We measured VATI, subcutaneous adipose tissue index (SATI) via computed tomography (CT). ER was defined as recurrence within 2 years after hepatectomy. The impact of parameters on outcome after hepatectomy for HCC was analyzed. Results Univariate analysis showed that alpha-fetoprotein levels (p = 0.044), body mass index (BMI) (p < 0.001), SATI (p < 0.001), and VATI (p < 0.001) were significantly different between ER and non-ER groups in internal training cohort. Multivariate analysis identified VATI as an independent risk factor for ER (odds ratio = 1.07, 95% confidence interval: 1.047-1.094, p < 0.001), with a AUC of 0.802, based on the cut-off value of VATI, which was divided into high risk (≥37.45 cm2/m2) and low risk (<37.45 cm2/m2) groups. The prognosis of low risk group was significantly higher than that of high risk group (p < 0.001). The AUC value of VATI in external validation group was 0.854. Conclusion VATI was an independent risk factor for the ER, and higher VATI was closely related to poor outcomes after hepatectomy for HBV-related HCC (≤5 cm).
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Affiliation(s)
- Zong-qian Wu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Cheng
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xi-xi Xiao
- Department of Oncology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hua-rong Zhang
- Institute of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Juan Peng
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China,Correspondence: Ping Cai Xiao-ming Li
| | - Xiao-ming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China,Correspondence: Ping Cai Xiao-ming Li
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Wang X, Sun X, Lei Y, Pei J, Ma K, Feng K, Lau WY, Xia F. Open Radiofrequency Ablation Combined with Splenectomy and Pericardial Devascularization vs. Liver Transplantation for Hepatocellular Carcinoma Patients with Portal Hypertension and Hypersplenism: A Case-Matched Comparative Study. J INVEST SURG 2023; 36:1-7. [DOI: 10.1080/08941939.2022.2130482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Xishu Wang
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
- Hygienic Company of 65529 Troops of PLA, Liaoyang, Liaoning, China
| | - Ximin Sun
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongrong Lei
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jun Pei
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Kai Feng
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Wan Yee Lau
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Feng Xia
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Tian Y, Hua H, Peng Q, Zhang Z, Wang X, Han J, Ma W, Chen J. Preoperative Evaluation of Gd-EOB-DTPA-Enhanced MRI Radiomics-Based Nomogram in Small Solitary Hepatocellular Carcinoma (≤3 cm) With Microvascular Invasion: A Two-Center Study. J Magn Reson Imaging 2022; 56:1459-1472. [PMID: 35298849 DOI: 10.1002/jmri.28157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Preoperative evaluation of microvascular invasion (MVI) in small solitary hepatocellular carcinoma (HCC; maximum lesion diameter ≤ 3 cm) is important for treatment decisions. PURPOSE To apply gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI to develop and validate a nomogram for preoperative evaluation of MVI in small solitary HCC and to compare the effectiveness of radiomics evaluation models based on different volumes of interest (VOIs). STUDY TYPE Retrospective. POPULATION A total of 196 patients include 62 MVI-positive and 134 MVI-negative patients were enrolled (training cohort, n = 105; testing cohort, n = 45; external validation cohort, n = 46). FIELD STRENGTH/SEQUENCE 3.0 T, fat suppressed fast-spin-echo T2-weighted and Gd-EOB-DTPA-enhanced T1-weighted magnetization-prepared rapid gradient-echo sequences. ASSESSMENT Radiomics features were extracted on T2-weighted, arterial phase (AP), and hepatobiliary phase (HBP) images from different VOIs (VOIintratumor and VOIintratumor+peritumor ) and filtered by the least absolute shrinkage selection operator (LASSO) regression. From VOIintratumor and VOIintratumor+peritumor , eight radiomics models were constructed based on three MRI sequences (T2-weighted, AP, and HBP) and fused sequences (combined of three sequences). Nomograms were constructed of a clinical-radiological (CR) model and a clinical-radiological-radiomics (CRR) model. STATISTICAL TESTS One-way analysis of variance, independent t-test, Chi-square test or Fisher's exact test, Wilcoxon rank-sum test, LASSO, logistic regression analysis, area under the curve (AUC), nomograms, decision curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI) analyses, and DeLong test. RESULTS Among eight radiomics models, the fused sequences-based VOIintratumor+peritumor radiomics model showed the best performance. The CRR model containing the best performance radiomics model and CR model with the AUC values were 0.934, 0.889, and 0.875, respectively. NRI and IDI analyses showed that the CRR model improved evaluation efficacy over the CR model for all three cohorts (all P-value <0.05). DATA CONCLUSION The CRR model nomogram could preoperatively evaluate MVI in small solitary HCC. The radiomics model based on VOIintratumor+peritumor might achieve better evaluation results. EVIDENCE LEVEL 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Yaqi Tian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiqi Peng
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zaixian Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolin Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junqi Han
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Ma
- Department of Breast Imaging, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Jingjing Chen
- Department of Breast Imaging, The Affiliated Hospital of Qingdao University, Qingdao, China
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An C, Yang H, Yu X, Han ZY, Cheng Z, Liu F, Dou J, Li B, Li Y, Li Y, Yu J, Liang P. A Machine Learning Model Based on Health Records for Predicting Recurrence After Microwave Ablation of Hepatocellular Carcinoma. J Hepatocell Carcinoma 2022; 9:671-684. [PMID: 35923613 PMCID: PMC9342890 DOI: 10.2147/jhc.s358197] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aim Early recurrence (ER) presents a challenge for the survival prognosis of patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate machine learning (ML) models using clinical data for predicting ER after microwave ablation (MWA). Methods Between August 2005 and December 2019, 1574 patients with early-stage HCC underwent MWA at four hospitals were reviewed. Then, 36 clinical data points per patient were collected, and the patients were assigned to the training, internal, and external validation set. Apart from traditional logistic regression (LR), three ML models—random forest, support vector machine, and eXtreme Gradient Boosting (XGBoost)—were built and validated for their predictive ability with the area under ROC curve (AUC). Algorithms such as SHapley Additive exPlanations (SHAP) and local interpretable model-agnostic explanations (LIME) were used to realize their interpretability. Results The three ML models all outperformed LR (P < 0.001 for all) in predictive ability. When nine variables (tumor number, platelet, α-fetoprotein, comorbidity score, white blood cell, cholinesterase, prothrombin time, neutrophils, and etiology) were extracted simultaneously using recursive feature elimination with cross-validation, the XGBoost model achieved the best discrimination among all models, with an AUC value 0.75 (95% CI [confidence interval]: 0.72–0.78) in the training set, 0.74 (95% CI: 0.69–0.80) in the internal validation set, and 0.76 (95% CI: 0.70–0.82) in the external validation set, and it was interpreted depending on the visualization of risk factors by the SHAP and LIME algorithms. The predictive system of post-ablation recurrence risk stratification was provided on online (http://114.251.235.51:8001/) based on XGboost analysis. Conclusion The XGBoost model based on clinical data can effectively predict ER risk after MWA, which can contribute to surveillance, prevention, and treatment strategies for HCC.
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Affiliation(s)
- Chao An
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Hongcai Yang
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- School of Medicine, Nankai University, Tianjin, People’s Republic of China
| | - Xiaoling Yu
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Zhi-Yu Han
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Zhigang Cheng
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Fangyi Liu
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Jianping Dou
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Bing Li
- National Laboratory of Pattern Recognition (NLPR), Institute of Automation, Chinese Academy of Sciences, Beijing, People’s Republic of China
| | - Yansheng Li
- DHC Mediway Technology CO, Ltd, Beijing, People’s Republic of China
| | - Yichao Li
- DHC Mediway Technology CO, Ltd, Beijing, People’s Republic of China
| | - Jie Yu
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Ping Liang
- Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Correspondence: Ping Liang; Jie Yu, Department of Ultrasound, PLA Medical College & 5th Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China, Tel +86-10-66939530, Fax +86-10-68161218, Email ;
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Wei MC, Zhang YJ, Chen MS, Chen Y, Lau WY, Peng ZW. Adjuvant Sorafenib Following Radiofrequency Ablation for Early-Stage Recurrent Hepatocellular Carcinoma With Microvascular Invasion at the Initial Hepatectomy. Front Oncol 2022; 12:868429. [PMID: 35814378 PMCID: PMC9260661 DOI: 10.3389/fonc.2022.868429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/23/2022] [Indexed: 01/27/2023] Open
Abstract
Background The efficacy of radiofrequency ablation (RFA) for patients with early-stage recurrent hepatocellular carcinoma (HCC) with microvascular invasion (MVI) at the initial hepatectomy is limited. Our study aimed to explore whether adjuvant sorafenib following RFA could improve the situation. Methods We retrospectively included 211 patients with early-stage (tumor number of ≤3 and tumor size of 2–5 cm) recurrent HCC with MVI at the initial hepatectomy who underwent adjuvant sorafenib following RFA or RFA alone in 13 centers from June 2013 to June 2020. In the combination group, sorafenib of 400 mg twice daily was administered within 7 days after RFA. Overall survival (OS) and recurrence-free survival (RFS) were compared. Subgroup analysis based on MVI grade was performed. MVI grade was based on the practice guidelines for the pathological diagnosis of HCC and included M1 (≤5 MVI sites, all located within adjacent peritumoral liver tissues 0–1 cm away from the tumor margin) and M2 (>5 MVI sites, or any MVI site located within adjacent peritumoral liver tissues > 1 cm away from the tumor margin). Results A total of 103 patients received the combination therapy and 108 patients received RFA alone. The combination therapy provided better survival than RFA alone (median RFS: 17.7 vs. 13.1 months, P < 0.001; median OS: 32.0 vs. 25.0 months, P = 0.002). Multivariable analysis revealed that treatment allocation was an independent prognostic factor. On subgroup analysis, the combination therapy provided better survival than RFA alone in patients with M1 along with either a tumor size of 3–5 cm, tumor number of two to three, or alpha-fetoprotein (AFP) > 400 μg/L, and in those with M2 along with either a tumor size of 2–3 cm, one recurrent tumor, or AFP ≤ 400 μg/L. Conclusions Adjuvant sorafenib following RFA was associated with better survival than RFA alone in patients with early-stage recurrent HCC with MVI at the initial hepatectomy. Moreover, MVI grade could guide the application of adjuvant sorafenib.
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Affiliation(s)
- Meng-Chao Wei
- Department of Liver Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yao-Jun Zhang
- Department of Liver Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Min-Shan Chen
- Department of Liver Surgery, Cancer Center, Sun Yat-sen University, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Yong Chen
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wan-Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, Hong Kong SAR, China
| | - Zhen-Wei Peng
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- The Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zhen-Wei Peng,
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Wu Z, Lu H, Xie Q, Cheng J, Ma K, Hu X, Tan L, Zhang H, Liu C, Li X, Cai P. Preoperative Assessment of Abdominal Adipose Tissue to Predict Microvascular Invasion in Small Hepatocellular Carcinoma. J Clin Transl Hepatol 2022; 10:184-189. [PMID: 35528977 PMCID: PMC9039711 DOI: 10.14218/jcth.2021.00126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Microvascular invasion (MVI) affects recurrence after treatment of small hepatocellular carcinoma (sHCC) of ≤3 cm in size. The present study aimed to investigate whether abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intermuscular adipose tissue (IMAT) are associated with MVI in patients with sHCC. METHODS A total of 124 patients with pathologically-confirmed sHCC diagnosed on surgical resection at the First Hospital Affiliated to Army Military University were recruited and divided into two groups according to MVI classification criteria (i.e., MVI-positive or MVI-negative). The SAT, VAT, and IMAT areas at the lumbar 3 vertebral level were imaged with abdominal computed tomography and measured using ImageJ software. Their association with MVI in sHCC was analyzed. RESULTS Of the 124 patients with sHCC, 67 were MVI-positive and 57 were MVI-negative. Univariate analysis revealed a significant difference in the abdominal VAT and SAT between the MVI-positive and MVI-negative groups (p<0.05), with an area under the receiver operating characteristic curve of 0.76 and 0.65, respectively. CONCLUSIONS The results of this study suggest that the areas of abdominal SAT and VAT are of significant clinical value because they can effectively predict the MVI status in patients with sHCC.
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Affiliation(s)
- Zongqian Wu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Lu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Qiao Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Cheng
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Kuansheng Ma
- Department of Hepatobiliary, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liang Tan
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Military Medical University), Chongqing, China
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | - Huarong Zhang
- Institute of Pathology and Southwest Cancer Center, Third Military Medical University (Army Military Medical University), Chongqing, China
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaoming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Correspondence to: Xiaoming Li and Ping Cai, Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China. Tel: +86-13594675445 (XL), +86-13228683331 (PC), Fax: +86-23-6546-3026, E-mail: (XL), (PC)
| | - Ping Cai
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
- Correspondence to: Xiaoming Li and Ping Cai, Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China. Tel: +86-13594675445 (XL), +86-13228683331 (PC), Fax: +86-23-6546-3026, E-mail: (XL), (PC)
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Wei M, Lin M, Zhong X, Dai Z, Shen S, Li S, Peng Z, Kuang M. Role of Preoperational Imaging Traits for Guiding Treatment in Single ≤ 5 cm Hepatocellular Carcinoma. Ann Surg Oncol 2022; 29:5144-5153. [DOI: 10.1245/s10434-022-11344-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 01/03/2022] [Indexed: 12/12/2022]
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Wen C, Tang J, Luo H. Development and Validation of a Nomogram to Predict Cancer-Specific Survival for Middle-Aged Patients With Early-Stage Hepatocellular Carcinoma. Front Public Health 2022; 10:848716. [PMID: 35296046 PMCID: PMC8918547 DOI: 10.3389/fpubh.2022.848716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background Hepatocellular carcinoma is a common cause of death in middle-aged patients. We aimed to construct a new nomogram to predict cancer-specific survival (CSS) in middle-aged patients with hepatocellular carcinoma at an early stage. Method We collected clinicopathological information on early middle-aged patients with hepatocellular carcinoma from the SEER database. Univariate and multivariate Cox regression models were used to screen the independent risk factors for prognosis. These risk factors were used to construct predictions of CSS in patients with hepatocellular carcinoma. Consistency index (C- index), calibration curve, area under the receiver operating curve (AUC) were used. A decision analysis curve (DCA) was used to evaluate the clinical utility of the predictive model. Results A total of 6,286 patients with hepatocellular carcinoma in early middle age were enrolled. Univariate and multivariate Cox regression analysis showed that sex, marriage, race, histological tumor grade, T stage, surgery, chemotherapy, AFP, and tumor size were independent risk factors for prognosis. All independent risk factors were included in the nomogram to predict CSS at 1-, 3-, and 5-years in early middle age patients with hepatocellular carcinoma. In the training cohort and validation cohort, the C-index of the prediction model was 0.728 (95%CI: 0.716–0.740) and 0.733 (95%CI: 0.715–0.751), respectively. The calibration curve showed that the predicted value of the prediction model is highly consistent with the observed value. AUC also suggested that the model has good discrimination. DCA suggested that the nomogram had better predictive power than T staging. Conclusion We constructed a new nomogram to predict CSS in middle-aged patients with early-stage hepatocellular carcinoma. This prediction model has good accuracy and reliability, which can help patients and doctors to judge prognosis and make clinical decisions.
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Affiliation(s)
- Chong Wen
- General Surgery Center, The General Hospital of Western Theater, Chengdu, China
- College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
| | - Hao Luo
- General Surgery Center, The General Hospital of Western Theater, Chengdu, China
- *Correspondence: Hao Luo
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Li M, Yin Z, Hu B, Guo N, Zhang L, Zhang L, Zhu J, Chen W, Yin M, Chen J, Ehman RL, Wang J. MR Elastography-Based Shear Strain Mapping for Assessment of Microvascular Invasion in Hepatocellular Carcinoma. Eur Radiol 2022; 32:5024-5032. [PMID: 35147777 DOI: 10.1007/s00330-022-08578-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the potential of MR elastography (MRE)-based shear strain mapping to noninvasively predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma (HCC). METHODS Fifty-nine histopathology-proven HCC patients with conventional 60-Hz MRE examinations (+/-MVI, n = 34/25) were enrolled retrospectively between December 2016 and October 2019, with one subgroup comprising 29/59 patients (+/-MVI, n = 16/13) who also underwent 40- and 30-Hz MRE examinations. Octahedral shear strain (OSS) maps were calculated, and the percentage of peritumoral interface length with low shear strain (i.e., a low-shear-strain length, pLSL, %) was recorded. For OSS-pLSL, differences between the MVI (+) and MVI (-) groups and diagnostic performance at different MRE frequencies were analyzed using the Mann-Whitney test and area under the receiver operating characteristic curve (AUC), respectively. RESULTS The peritumor OSS-pLSL was significantly higher in the MVI (+) group than in the MVI (-) group at the three frequencies (all p < 0.01). The AUC of peritumor OSS-pLSL for predicting MVI was good/excellent in all frequency groups (60-Hz: 0.73 (n = 59)/0.80 (n = 29); 40-Hz: 0.84; 30-Hz: 0.90). On further analysis of the 29 cases with all frequencies, the AUCs were not significantly different. As the frequency decreased from 60-Hz, the specificity of OSS increased at 40-Hz (53.8-61.5%) and further increased at 30-Hz (53.8-76.9%), and the sensitivity remained high at lower frequencies (100.0-93.8%) (all p > 0.05). CONCLUSIONS MRE-based shear strain mapping is a promising technique for noninvasively predicting the presence of MVI in patients with HCC, and the most recommended frequency for OSS is 30-Hz. KEY POINTS • MR elastography (MRE)-based shear strain mapping has the potential to predict the presence of microvascular invasion (MVI) in hepatocellular carcinoma preoperatively. • The low interface shear strain identified at tumor-liver boundaries was highly correlated with the presence of MVI.
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Affiliation(s)
- Mengsi Li
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ziying Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bing Hu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Ning Guo
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Linqi Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Lina Zhang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jie Zhu
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Wenying Chen
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Meng Yin
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jun Chen
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Richard L Ehman
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jin Wang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-Sen University (SYSU), No 600, Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
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He T, Chen T, Liu X, Zhang B, Yue S, Cao J, Zhang G. A Web-Based Prediction Model for Cancer-Specific Survival of Elderly Patients With Early Hepatocellular Carcinoma: A Study Based on SEER Database. Front Public Health 2022; 9:789026. [PMID: 35096742 PMCID: PMC8792840 DOI: 10.3389/fpubh.2021.789026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Primary liver cancer is a common malignant tumor primarily represented by hepatocellular carcinoma (HCC). The number of elderly patients with early HCC is increasing, and older age is related to a worse prognosis. However, an accurate predictive model for the prognosis of these patients is still lacking. Methods: Data of eligible elderly patients with early HCC in Surveillance, Epidemiology, and End Results database from 2010 to 2016 were downloaded. Patients from 2010 to 2015 were randomly assigned to the training cohort (n = 1093) and validation cohort (n = 461). Patients' data in 2016 (n = 431) was used for external validation. Independent prognostic factors were obtained using univariate and multivariate analyses. Based on these factors, a cancer-specific survival (CSS) nomogram was constructed. The predictive performance and clinical practicability of our nomogram were validated. According to the risk scores of our nomogram, patients were divided into low-, intermediate-, and high-risk groups. A survival analysis was performed using Kaplan–Meier curves and log-rank tests. Results: Age, race, T stage, histological grade, surgery, radiotherapy, and chemotherapy were independent predictors for CSS and thus were included in our nomogram. In the training cohort and validation cohort, the concordance indices (C-indices) of our nomogram were 0.739 (95% CI: 0.714–0.764) and 0.756 (95% CI: 0.719–0.793), respectively. The 1-, 3-, and 5-year areas under receiver operating characteristic curves (AUCs) showed similar results. Calibration curves revealed high consistency between observations and predictions. In external validation cohort, C-index (0.802, 95%CI: 0.778–0.826) and calibration curves also revealed high consistency between observations and predictions. Compared with the TNM stage, nomogram-related decision curve analysis (DCA) curves indicated better clinical practicability. Kaplan–Meier curves revealed that CSS significantly differed among the three different risk groups. In addition, an online prediction tool for CSS was developed. Conclusions: A web-based prediction model for CSS of elderly patients with early HCC was constructed and validated, and it may be helpful for the prognostic evaluation, therapeutic strategy selection, and follow-up management of these patients.
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Affiliation(s)
- Taiyu He
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tianyao Chen
- College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Biqiong Zhang
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Song Yue
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junyi Cao
- Department of Record Room, Zigong First People's Hospital, Zigong, China
| | - Gaoli Zhang
- Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Chongqing Medical University, Chongqing, China
- Institute for Viral Hepatitis, Chongqing Medical University, Chongqing, China
- Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Gaoli Zhang
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Wang J, Ding ZW, Chen K, Liu YZ, Li N, Hu MG. A predictive and prognostic model for hepatocellular carcinoma with microvascular invasion based TCGA database genomics. BMC Cancer 2021; 21:1337. [PMID: 34911488 PMCID: PMC8675478 DOI: 10.1186/s12885-021-09047-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Microvascular invasion (MVI) adversely affects postoperative long-term survival outcomes in patients with hepatocellular carcinoma (HCC). There is no study addressing genetic changes in HCC patients with MVI. We first screened differentially expressed genes (DEGs) in patients with and without MVI based on TCGA data, established a prediction model and explored the prognostic value of DEGs for HCC patients with MVI. Methods In this paper, gene expression and clinical data of liver cancer patients were downloaded from the TCGA database. The DEG analysis was conducted using DESeq2. Using the least absolute shrinkage and selection operator, MVI-status-related genes were identified. A Kaplan-Meier survival analysis was performed using these genes. Finally, we validated two genes, HOXD9 and HOXD10, using two sets of HCC tissue microarrays from 260 patients. Results Twenty-three MVI-status-related key genes were identified. Based on the key genes, we built a classification model using random forest and time-dependent receiver operating characteristic (ROC), which reached 0.814. Then, we performed a survival analysis and found ten genes had a significant difference in survival time. Simultaneously, using two sets of 260 patients’ HCC tissue microarrays, we validated two key genes, HOXD9 and HOXD10. Our study indicated that HOXD9 and HOXD10 were overexpressed in HCC patients with MVI compared with patients without MVI, and patients with MVI with HOXD9 and 10 overexpression had a poorer prognosis than patients with MVI with low expression of HOXD9 and 10. Conclusion We established an accurate TCGA database-based genomics prediction model for preoperative MVI risk and studied the prognostic value of DEGs for HCC patients with MVI. These DEGs that are related to MVI warrant further study regarding the occurrence and development of MVI. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09047-1.
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Affiliation(s)
- Jin Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Wen Ding
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China
| | - Kuang Chen
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Zhe Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Nan Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, China.
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Zhou JM, Zhou CY, Chen XP, Zhang ZW. Anatomic resection improved the long-term outcome of hepatocellular carcinoma patients with microvascular invasion: A prospective cohort study. World J Gastrointest Oncol 2021; 13:2190-2202. [PMID: 35070051 PMCID: PMC8713310 DOI: 10.4251/wjgo.v13.i12.2190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/05/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The long-term effect of anatomic resection (AR) is better than that of non-anatomic resection (NAR). At present, there is no study on microvascular invasion (MVI) and liver resection types.
AIM To explore whether AR improves long-term survival in patients with hepatocellular carcinoma (HCC) by removing the peritumoral MVI.
METHODS A total of 217 patients diagnosed with HCC were enrolled in the study. The surgical margin was routinely measured. According to the stratification of different tumor diameters, patients were divided into the following groups: ≤ 2 cm group, 2-5 cm group, and > 5 cm group.
RESULTS In the 2-5 cm diameter group, the overall survival (OS) of MVI positive patients was significantly better than that of MVI negative patients (P = 0.031). For the MVI positive patients, there was a statistically significant difference between AR and NAR (P = 0.027). AR leads to a wider surgical margin than NAR (2.0 ± 2.3 cm vs 0.7 ± 0.5 cm, P < 0.001). In the groups with tumor diameters < 2 cm, both AR and NAR can obtain a wide surgical margin, and the surgical margins of AR are wider than that of NAR (3.5 ± 5.8 cm vs 1.6 ± 0.5 cm, P = 0.048). In the groups with tumor diameters > 5 cm, both AR and NAR fail to obtain wide surgical margin (0.6 ± 1.0 cm vs 0.7 ± 0.4 cm, P = 0.491).
CONCLUSION For patients with a tumor diameter of 2-5 cm, AR can achieve the removal of peritumoral MVI by obtaining a wide incision margin, reduce postoperative recurrence, and improve prognosis.
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Affiliation(s)
- Jiang-Min Zhou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Chen-Yang Zhou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Ping Chen
- Translational Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zhi-Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Tohra S, Duseja A, Taneja S, Kalra N, Gorsi U, Behera A, Kaman L, Dahiya D, Sahu S, Sharma B, Singh V, Dhiman RK, Chawla Y. Experience With Changing Etiology and Nontransplant Curative Treatment Modalities for Hepatocellular Carcinoma in a Real-Life Setting-A Retrospective Descriptive Analysis. J Clin Exp Hepatol 2021; 11:682-690. [PMID: 34866847 PMCID: PMC8617543 DOI: 10.1016/j.jceh.2021.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) has variable etiological risk factors. Radiofrequency ablation (RFA) and surgical resection (SR) are frequently used as curative treatment options. In the present study, we assessed the etiological factors and efficacy of RFA and SR in patients with unifocal HCC in a real-life setting. METHODS Of 870 patients with HCC seen over a period of nine years, 785 patients were assessed for stage and etiological risk factors. Of these, 110 (14%) patients with single HCC who were either treated with RFA (n = 72) or SR (n = 38) were evaluated for their outcomes in terms of overall survival (OS) and disease-free survival (DFS) over 3 years. RESULTS Of 785 patients [median age 60 (range 51-65) years, males (n = 685, 87.3%)] with HCC, viral hepatitis [HBV and HCV with or without alcohol = 502 (63.9%)] was the most common etiology; nonalcoholic steatohepatitis (NASH) and alcohol as an etiology showed increase over the years. About 677 (86.2%) patients had evidence of cirrhosis; NASH and HBV were predominant causes in noncirrhotic patients. Even though the groups were not matched, in 110 patients subjected to either RFA [mean tumor size, 2.2 (1.9-2.8) cm] or SR [mean tumor size, 7.1 (4.8-9.7) cm], tumor progression was observed in 49 (68%) and 16 (42%) patients in RFA and SR groups, respectively, with superior DFS in the SR group (P < 0.01). Of total 31 deaths, 20 (27.8%) deaths were in the RFA group and 11 (28.9%) in the SR group with no difference in OS at 3 years. CONCLUSION Viral hepatitis with or without alcohol is the commonest etiological factor for HCC in Northern India; NASH and alcohol are increasing over the years. In a real-life setting, in patients with unifocal HCC, there is no difference in overall 3-year survival subjected to SR or RFA with better DFS in the SR group.
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Key Words
- AFP, Alpha Fetoprotein
- BCLC, Barcelona Clinic Liver Cancer
- CEMR, Contrast-Enhanced Magnetic Resonance Imaging
- CLD, Chronic Liver Disease
- DFS, Disease-free Survival
- HBV, Hepatitis B Virus
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- LT, Liver Transplantation
- NAFLD, Non -Alcoholic Fatty Liver Disease
- NASH
- NASH, Non-alcoholic Steatohepatitis
- OS, Overall Survival
- RFA, Radiofrequency Ablation
- SR, Surgical Resection
- TPCT, Triple-Phase Contrast-enhanced computerized Tomography
- alcohol
- hepatitis B virus
- hepatitis C virus
- nonalcoholic fatty liver disease
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Affiliation(s)
- Suneel Tohra
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ajay Duseja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
- Address for correspondence. Ajay Duseja, Professor, Department of Hepatology, Post Graduate Institute of Medical Education and Research, Sector 12,Chandigarh, 160012, India.
| | - Sunil Taneja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naveen Kalra
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ujjwal Gorsi
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arunanshu Behera
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh,160012 India
| | - Lileswar Kaman
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh,160012 India
| | - Divya Dahiya
- General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh,160012 India
| | - Srimanta Sahu
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Balkrishan Sharma
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Virendra Singh
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Radha K. Dhiman
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Yogesh Chawla
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Jeong J, Park JG, Seo KI, Ahn JH, Park JC, Yun BC, Lee SU, Lee JW, Yun JH. Microvascular invasion may be the determining factor in selecting TACE as the initial treatment in patients with hepatocellular carcinoma. Medicine (Baltimore) 2021; 100:e26584. [PMID: 34232206 PMCID: PMC8270609 DOI: 10.1097/md.0000000000026584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 05/06/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The aim of this study was to investigate factors affecting tumor necrosis with transcatheter arterial chemoembolization (TACE). Factors associated with early hepatocellular carcinoma recurrence after curative hepatectomy were also evaluated.Data of 51 patients who underwent surgery after a single session of TACE at a single university hospital were retrospectively analyzed. Factors that might affect tumor necrosis were determined by evaluating the TACE approach and by analyzing computed tomography and TACE findings, pathologic reports, and laboratory findings.In univariate analysis, microvascular invasion (MVI), radiological capsule appearance on the computed tomography, chronic hepatitis B, diabetes mellitus and serum albumin, MVI were significantly associated with tumor necrosis by TACE (P < .02). In multivariate analysis, MVI was the only statistically significant factor in TACE-induced tumor necrosis (P = .001). In univariate and multivariate analysis, MVI was the strongest factor for recurrence-free survival rate within 2 years (P = .008, P = .002).MVI could be a crucial factor in determining TACE as an initial treatment for hepatocellular carcinoma. MVI is also a strong indicator of recurrence within 2 years after curative hepatic resection.
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Affiliation(s)
- Joonho Jeong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan
| | | | - Kwang Ill Seo
- Division of Hepatology, Department of Internal Medicine
| | - Ji Hyun Ahn
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | | | | | - Sang Uk Lee
- Division of Hepatology, Department of Internal Medicine
| | - Jin Wook Lee
- Division of Hepatology, Department of Internal Medicine
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Yoh T, Seo S, Ogiso S, Morino K, Fukumitsu K, Ishii T, Nakamoto Y, Taura K. Quantitative assessment of microvascular invasion in hepatocellular carcinoma using preoperative serological and imaging markers. HPB (Oxford) 2021; 23:1039-1045. [PMID: 33262049 DOI: 10.1016/j.hpb.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to establish a quantitative equation to predict microvascular invasion (MVI) for patients with resectable hepatocellular carcinoma (HCC). METHODS This retrospective study included 219 patients with resected HCC from 2004 to 2015. All had available three pre-operative serological markers (alfa-feto protein (AFP), fucosylated AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP)), and one imaging marker (tumor to liver ratio of SUVmax (TLR) by 18F-FDG-PET). A multiple linear regression model for predicting MVI was developed (2004-2009, n = 111) and then validated (2010-2015, n = 108). Further, impact on the obtained model on survival outcomes was assessed. RESULTS Using the derivation cohort, following equation was developed; MVI probability (%) = 14.2 × log10DCP + 9.9 × TLR - 22.0. This model resulted in an area under receiver operating characteristic curve (ROC) of 0.806 and 0.751, in the derivation and validation cohort, respectively. Furthermore, MVI probability ≥40% determined by ROC analysis was associated with worse overall survival and recurrence-free survival in the derivation and the validation cohort (all p < 0.05). CONCLUSION A quantitative model, using DCP and TLR, was able to preoperatively predict with good performance MVI and long-term outcomes in patients with HCC after liver resection.
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Affiliation(s)
- Tomoaki Yoh
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Satoshi Ogiso
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koshiro Morino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Fukumitsu
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Wang LL, Li JF, Lei JQ, Guo SL, Li JK, Xu YS, Dou Y. The value of the signal intensity of peritumoral tissue on Gd-EOB-DTPA dynamic enhanced MRI in assessment of microvascular invasion and pathological grade of hepatocellular carcinoma. Medicine (Baltimore) 2021; 100:e25804. [PMID: 34011043 PMCID: PMC8136999 DOI: 10.1097/md.0000000000025804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
The aim of the study was to assess the potential role of preoperative gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) dynamic enhanced MR imaging for diagnosing microvascular invasion (MVI) and pathological grade of hepatocellular carcinoma (HCC).A total of 113 consecutive HCC patients confirmed by histopathology underwent preoperative Gd-EOB-DTPA dynamic enhanced MRI were included. Signal intensity (SI) of peritumoral, normal liver tissue and tumor parenchyma during arterial phase and hepatobiliary phase (HBP) were analyzed. The receiver operating characteristic (ROC) curves were performed to assess the potential diagnostic capability for MVI and pathological grade of HCC. Kaplan-Meier method was performed to estimate the recurrence-free survival rate and compared using the log rank test.SI ratio of peritumoral tissue to normal liver in arterial phase (SIAp/Al) was independently associated with MVI [odds ratio (OR) = 3.115, 95% confidence interval (CI): 1.867-5.198] and pathological grades (OR = 1.437, 95% CI: 1.042-1.981). The area under the curve (AUC) of SIAp/Al was equivalent to the SI of tumor parenchyma on arterial phase (SIAt) in distinguishing low and high pathological grades. However, the AUC of SIAp/Al (0.851) was larger than peritumoral hypointensity on HBP (0.668) for distinguishing MVI. The recurrence-free survival rate of HCC patients with SIAp/Al<1.1 was higher than HCC with SIAp/Al≥1.1(P = .025).The SIAp/Al in preoperative Gd-EOB-DTPA dynamic enhanced MR imaging is a potential diagnosis marker for MVI and pathological grade of HCC noninvasively. The higher SIAp/Al may predict the poor prognosis of HCC after surgery.
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Affiliation(s)
- Li-Li Wang
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Jun-Feng Li
- First Clinical Medical School of Lanzhou University
- Institute of Infectious Diseases, Department of Infectious Diseases, First Hospital of Lanzhou University, Lanzhou, China
| | - Jun-Qiang Lei
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Shun-Lin Guo
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Jin-Kui Li
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Yong-Sheng Xu
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
| | - Yu Dou
- First Clinical Medical School of Lanzhou University
- Department of Radiology, First Hospital of Lanzhou University
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Key Enzymes in Pyrimidine Synthesis, CAD and CPS1, Predict Prognosis in Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13040744. [PMID: 33670206 PMCID: PMC7916936 DOI: 10.3390/cancers13040744] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with hepatocellular carcinoma (HCC) have a highly variable clinical course. Therefore, there is an urgent need to identify new prognostic markers to determine prognosis and select specific therapies. Recently, it has been demonstrated that dysregulation of the urea cycle (UC) is a common phenomenon in multiple types of cancer. Upon UC dysregulation, nitrogen is diverted toward the multifunctional enzyme carbamoyl-phosphate synthetase 2, aspartate transcarbamoylase, and dihydroorotase (CAD), and increases pyrimidine synthesis. In this study, we investigated the role of CAD and carbamoyl-phosphate synthetase 1 (CPS1), a rate-limiting enzyme of the UC highly expressed in hepatocytes, in HCC. We created a tissue microarray to analyze expression of both enzymes by immunohistochemistry in a large and well-characterized overall cohort of 871 HCCs of 561 patients that underwent surgery. CAD was induced in recurrent HCCs, and high expression predicted shorter overall survival. CPS1 was downregulated in HCC and further reduced in recurrent tumors and distant metastases. Additionally, low CPS1 was associated with short overall survival. A combined score of both enzymes was an independent prognostic marker in a multivariate Cox regression model (HR = 1.37, 95% confidence interval 1.06-1.75, p = 0.014). Inhibition of pyrimidine synthesis may represent a novel therapeutic strategy for HCC.
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Yan B, Su BB, Bai DS, Qian JJ, Zhang C, Jin SJ, Jiang GQ. A practical nomogram and risk stratification system predicting the cancer-specific survival for patients with early hepatocellular carcinoma. Cancer Med 2020; 10:496-506. [PMID: 33280269 PMCID: PMC7877377 DOI: 10.1002/cam4.3613] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Our purpose was to establish and validate a nomogram model in early hepatocellular carcinoma (HCC) patients for predicting the cancer-specific survival (CSS). METHODS We extracted eligible data of relevant patients between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Further, we divided all patients into two groups (training and validation cohorts) at random (7:3). Nomogram was established using effective risk factors based on univariate and multivariate analysis. The effective performance of nomogram was evaluated using concordance index (C-index), calibration plots, decision curve analysis (DCA), and receiver operating characteristic curve (ROC). RESULTS We selected 3620 patients with early HCC including the training cohort (70%, 2536) and the validation cohort (30%, 1084). The nomogram-related C-indexes were 0.755 (95% CI: 0.739-0.771) and 0.737 (95% CI: 0.712-0.762), in the training and validation cohorts, respectively. The calibration plots showed good consistency of 3-and 5-year CSS between the actual observation and the nomogram prediction. The 3-, 5-year DCA curves also indicated that the nomogram has excellent clinical utility. The 3-, 5-year area under curve (AUC) of ROC in the training cohort were 0.783, 0.779, respectively, and 0.767, 0.766 in the validation cohort, respectively. With the establishment of nomogram, a risk stratification system was also established that could divide all patients into three risk groups, and the CSS in different groups (i.e., low risk, intermediate risk, and high risk) had a good regional division. CONCLUSIONS We developed a practical nomogram in early HCC patients for predicting the CSS, and a risk stratification system follow arisen, which provided an applicable tool for clinical management.
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Affiliation(s)
- Bing Yan
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian, China
| | - Bing-Bing Su
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Dou-Sheng Bai
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jian-Jun Qian
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Chi Zhang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Sheng-Jie Jin
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Guo-Qing Jiang
- Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China
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Zhou J, Zhang Z, Zhou H, Leng C, Hou B, Zhou C, Hu X, Wang J, Chen X. Preoperative circulating tumor cells to predict microvascular invasion and dynamical detection indicate the prognosis of hepatocellular carcinoma. BMC Cancer 2020; 20:1047. [PMID: 33129301 PMCID: PMC7603758 DOI: 10.1186/s12885-020-07488-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023] Open
Abstract
Background This study explored the diagnostic power of preoperative circulating tumor cells (CTCs) for the presence of microvascular invasion (MVI) and the relationship between dynamic changes in postoperative CTCs and prognosis. Methods A total of 137 patients were recruited for the study. Preoperative blood samples were collected from all patients to detect CTCs. The time points for blood collection were before the operation, during the operation, and at 1 week, 1 month, 2 months, 3 months, 6 months, and 1 year after surgery. The predictive power of CTC count for the presence of MVI was analyzed by receiver operating characteristic (ROC) curve analysis. According to recurrence status, 137 patients were divided into three groups: no recurrence, early recurrence, and non-early recurrence groups. Results A threshold CTC count of 5 showed the most significant power for predicting the existence of MVI. In multivariate analysis, the parameters of preoperative CTC count, alpha-fetoprotein (AFP) and tumor diameter were independent predictors of MVI (P < 0.05). A CTC count greater than or equal to 5 had better predictive value than AFP > 400 μg/L and tumor diameter > 5 cm. The number of intraoperative CTCs in the three groups did not increase compared to that before surgery (P > 0.05). The number of CTCs in the nonrecurrence group and the non-early recurrence group decreased significantly 1 week after surgery compared with the intraoperative values (P < 0.001), although there was no significant difference in the early recurrence group (P = 0.95). Patients with mean CTC count ≥5 had significantly worse long-term outcomes than those with mean CTC count < 5 (P < 0.001). Conclusion The preoperative CTC counts in the peripheral blood of patients with HCC are closely correlated with MVI. The intraoperative manipulation of the lesion by the surgeon does not increase the number of CTCs in peripheral blood. Surgical removal of the tumor decreases the number of CTCs. The persistence of CTCs at a high level (≥ 5) after surgery suggests a risk of early recurrence. Clinical trial registration Registration number is ChiCTR-OOC-16010183, date of registration is 2016-12-18.
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Affiliation(s)
- Jiangmin Zhou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Zhiwei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
| | - Honghao Zhou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Chao Leng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Bingwu Hou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Chenyang Zhou
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Xinsheng Hu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Jinlin Wang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Xiaoping Chen
- Translational Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Wang X, Zhang Z, Zhou X, Zhang Y, Zhou J, Tang S, Liu Y, Zhou Y. Computational quantitative measures of Gd-EOB-DTPA enhanced MRI hepatobiliary phase images can predict microvascular invasion of small HCC. Eur J Radiol 2020; 133:109361. [PMID: 33120240 DOI: 10.1016/j.ejrad.2020.109361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 10/11/2020] [Accepted: 10/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study was designed to preoperatively predict microvascular invasion (MVI) of solitary small hepatocellular carcinoma (sHCC) by quantitative analysis of Gd-EOB-DTPA enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI). METHOD Sixty-one patients, 19 with and 42 without histologically confirmed MVI following hepatic resection for solitary sHCC (≤ 3 cm), were preoperatively examined with Gd-EOB-DTPA-enhanced MRI. The regions of interest (ROIs) of the hepatic lesions were manually delineated on the maximum cross-sectional area in the HBP images and used to calculate the lesion boundary index (LBI) and marginal gray changes (MGC). Histogram analysis was performed to measure standard deviations (STD) and coefficients of variation (CV). Correlations between quantitative parameters and MVI were evaluated and differences between MVI positive and negative groups were assessed. RESULTS The average LBI (0.85 ± 0.07) and MGC (0.48 ± 0.27) values of the negative group were significantly higher (p < 0.05) than the corresponding LBI (0.72 ± 0.07) and MGC (0.28 ± 0.18) values of the positive group. STDs and CVs in the negative group were significantly smaller (p < 0.05) than those of the positive group. Receiver operating characteristic (ROC) analysis revealed that LBI had the best predictive value with an AUC, sensitivity, and specificity of 0.91, 87 %, and 80 %, respectively. CONCLUSIONS Quantitative analysis of HBP images is useful for predicting MVI and beneficial to clinicians in making decisions before treatment.
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Affiliation(s)
- Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Ziqian Zhang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Xueyan Zhou
- School of Technology, Harbin University, 109 Zhongxing Street, Harbin 150010, Heilongjiang, China
| | - Yuning Zhang
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Jiamin Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Shuli Tang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China
| | - Yang Liu
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China.
| | - Yang Zhou
- Department of Radiology, Harbin Medical University Cancer Hospital, 150 Haping Road, Harbin 150010, Heilongjiang, China.
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Finotti M, Vitale A, Volk M, Cillo U. A 2020 update on liver transplant for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2020; 14:885-900. [PMID: 32662680 DOI: 10.1080/17474124.2020.1791704] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Hepatocellular carcinoma is the most frequent liver tumor and is associated with chronic liver disease in 90% of cases. In selected cases, liver transplantation represents an effective therapy with excellent overall survival. AREA COVERED Since the introduction of Milan criteria in 1996, numerous alternative selection systems to LT for HCC patients have been proposed. Debate remains about how best to select HCC patients for transplant and how to prioritize them on the waiting list. EXPERT OPINION The selection of the best scoring system to propose in the context of LT for HCC is far to be identified. In this review, we analyze and categorize the various selection systems, assessing their roles in the different decisional phases.
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Affiliation(s)
- Michele Finotti
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital , Padova, Italy
| | - Alessandro Vitale
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital , Padova, Italy
| | - Michael Volk
- Division of Gastroenterology and Hepatology, Loma Linda University Health , Loma Linda, California, USA
| | - Umberto Cillo
- Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, Padova University Hospital , Padova, Italy
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Yamashita YI, Hayashi H, Imai K, Okabe H, Nakagawa S, Kitamura F, Uemura N, Nakao Y, Yusa T, Itoyama R, Yamao T, Umesaki N, Miyata T, Chikamoto A, Shimokawa M, Baba H. Perioperative Allogeneic Blood Transfusion Does not Influence Patient Survival After Hepatectomy for Hepatocellular Carcinoma: A Propensity Score Matching Analysis. World J Surg 2020; 43:2894-2901. [PMID: 31312946 DOI: 10.1007/s00268-019-05085-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether perioperative allogeneic blood transfusion (PABT) negatively influences patient survival after hepatectomy (HR) for hepatocellular carcinoma (HCC) remains controversial. METHODS Five hundred two patients who underwent HR for initial HCC between 1994 and 2015 were enrolled in this study. All patients were divided into two groups: the PABT group and the non-PABT group. Differences of clinicopathological factors, overall survival (OS), recurrence-free survival (RFS), and the recurrence pattern between the two groups were evaluated. Using propensity score matching for tumor-related factors, liver functions, and surgical factors (total 11 factors), the survival impact of PABT was also analyzed. RESULTS In the entire cohort, 78 patients (15.5%) received PABT such as red cell concentrate, fresh-frozen plasma, or platelets. OS (5-year OS: 55% vs. 76%; p = 0.0005) and RFS (2-year RFS: 47% vs. 56%; p = 0.0131) were significantly worse in the PABT group. The extrahepatic recurrence happened more frequently in the PABT group (15% vs. 5.4%; p = 0.0039). There were many significant clinicopathological differences between the two groups: more advanced tumor stage (tumor diameter, stage III or IV, microvascular invasion), worse liver functions (albumin, indocyanine green retention rate at 15 min), and more surgical stress (blood loss, operation time) in the PABT group. After propensity score matching, 43 pairs of patients were extracted. In this matched cohort, the survival curves of the PABT and non-PABT groups almost completely overlapped both in OS (5-year OS: 62% vs. 62%; p = 0.4384) and in RFS (2-year RFS: 49% vs. 47%; p = 0.8195). The significant difference of the extrahepatic recurrence rate disappeared in the matched cohort (p = 0.5789). CONCLUSION Using propensity score matching, we found that PABT does not influence patient survival after HR for HCC.
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Affiliation(s)
- Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Fumimasa Kitamura
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Norio Uemura
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yosuke Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toshihiko Yusa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Rumi Itoyama
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takanobu Yamao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Naoki Umesaki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Mototsugu Shimokawa
- Clinical Research Institute, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Yonemura Y, Yoshizumi T, Inokuchi S, Kosai‐Fujimoto Y, Harada N, Itoh S, Toshima T, Takeishi K, Yoshiya S, Mori M. Predictor of outcome after living donor liver transplantation for patients with hepatocellular carcinoma beyond the Japan criteria. Ann Gastroenterol Surg 2020; 4:413-421. [PMID: 32724885 PMCID: PMC7382431 DOI: 10.1002/ags3.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/11/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The Japan criteria (JC, maximum tumor size within 5 cm, within five tumor nodules, AFP within 500 ng/mL or within Milan criteria) have been applied to cadaveric liver transplantation (LT) for hepatocellular carcinoma (HCC) and will be used for living donor LT (LDLT) in Japan. The aim of this study was to verify the JC in LDLT and to clarify the risk factor of HCC recurrence and mortality after LDLT beyond the JC. PATIENTS AND METHODS Adult patients who underwent LDLT for end-stage liver disease with HCC until October 2019 were reviewed retrospectively (n = 246). Patients were divided into two groups according to whether they were within JC (n = 203) or beyond JC (n = 43). Recurrence-free or overall survival rates after LDLT were compared. Univariate and multivariate analyses were performed to identify risk factors of HCC recurrence and HCC-related mortality after LDLT for patients beyond the JC. RESULTS Patients beyond the JC had significantly poorer 5-year recurrence-free (50.3% vs 95.9%, P < .001) or overall (61.7% vs 98.1%, P < .001) survival rates compared with patients within the JC. A multivariate analysis revealed that des-gamma-carboxy prothrombin (DCP) ≥ 300 mAU/mL (hazard ratio 9.36, 95% CI; 2.41-36.4, P = .001) was an independent risk factor for HCC recurrence and HCC-related mortality (hazard ratio 13.8, 95% CI; 1.92-98.6, P = .01) after LDLT in patients beyond the JC. CONCLUSION The outcome of LDLT for patients within the JC was favorable. Patients beyond the JC with DCP ≥ 300 mAU/mL might be contraindicated for LDLT.
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Affiliation(s)
| | - Tomoharu Yoshizumi
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shoichi Inokuchi
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yukiko Kosai‐Fujimoto
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Noboru Harada
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shinji Itoh
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Takeo Toshima
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Kazuki Takeishi
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Shohei Yoshiya
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Masaki Mori
- Department of Surgery and ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
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Wan S, Nie Y, Zhu X. Development of a prognostic scoring model for predicting the survival of elderly patients with hepatocellular carcinoma. PeerJ 2020; 8:e8497. [PMID: 32117619 PMCID: PMC7006515 DOI: 10.7717/peerj.8497] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022] Open
Abstract
Background The number of elderly hepatocellular carcinoma (HCC) patients is increasing, and precisely assessing of the prognosis of these patients is necessary. We developed a prognostic scoring model to predict survival in elderly HCC patients. Methods We extracted data from 4,076 patients ≥65 years old from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided them into training and validation groups. Cox regression analysis was used to screen for meaningful independent prognostic factors. The receiver operating characteristic curve reflected the model's discrimination power. Results Age, race, American Joint Committee on Cancer stage, degree of tumour differentiation, tumour size, alpha-fetoprotein and tumour therapy were independent prognostic factors for survival in elderly HCC patients. We developed a prognostic scoring model based on the seven meaningful variables to predict survival in elderly HCC patients. The AUCs of the model were 0.805 (95% CI [0.788-0.821]) and 0.788 (95% CI [0.759-0.816]) in the training and validation groups, respectively. We divided the patients into low-risk groups and high-risk groups according to the optimal cut-off value. The Kaplan-Meier survival curve showed that in the training and validation groups, the survival rate of the low-risk group was significantly higher than that of the high-risk group (P < 0.001). Conclusion Based on a large population, we constructed a prognostic scoring model for predicting survival in elderly HCC patients. The model may provide a reference for clinicians for preoperative and postoperative evaluations of elderly HCC patients.
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Affiliation(s)
- Sizhe Wan
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuan Nie
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xuan Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Sun SW, Liu QP, Xu X, Zhu FP, Zhang YD, Liu XS. Direct Comparison of Four Presurgical Stratifying Schemes for Prediction of Microvascular Invasion in Hepatocellular Carcinoma by Gadoxetic Acid-Enhanced MRI. J Magn Reson Imaging 2020; 52:433-447. [PMID: 31943465 DOI: 10.1002/jmri.27043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Microvascular invasion (MVI) is implicated in the poor prognosis of hepatocellular carcinoma (HCC). Presurgical stratifying schemes have been proposed for HCC-MVI but lack external validation. PURPOSE To perform external validation and comparison of four presurgical stratifying schemes for the prediction of MVI using gadoxetic acid-based MRI in a cohort of HCC patients. STUDY TYPE Retrospective. SUBJECTS Included were 183 surgically resected HCCs from patients who underwent pretreatment MRI. FIELD STRENGTH/SEQUENCE This includes 1.5-3.0 T with T2 , T1 , diffusion-weighted imaging (DWI), and dynamic gadoxetic acid contrast-enhancement imaging sequences. ASSESSMENT A two-trait predictor of venous invasion (TTPVI), Lei model, Lee model, and Xu model were compared. We relied on preoperative characteristics and imaging findings via four independent radiologists who were blinded to histologic results, as required by the tested tools. STATISTICAL TEST Tests of accuracy between predicted and observed HCC-MVI rates using receiver operating characteristic (ROC) curve and decision curve analysis. The intraclass correlation coefficient (ICC) and Cronbach's alpha statistics were used to evaluate reproducibility. RESULTS HCC-MVI was identified in 52 patients (28.4%). The average ROC curves (AUCs) for HCC-MVI predictions were 0.709-0.880, 0.714-0.828, and 0.588-0.750 for the Xu model, Lei model, and Lee model, respectively. The rates of accuracy were 60.7-81.4%, 69.9-75.9%, and 65.6-73.8%, respectively. Decision curve analyses indicated a higher benefit for the Xu and Lei models compared to the Lee model. The ICC and Cronbach's alpha index were highest in the Lei model (0.896/0.943), followed by the Xu model (0.882/0.804), and the Lee model (0.769/0.715). The TTPVI resulted in a Cronbach's alpha index of 0.606 with a sensitivity of 34.6-61.5% and a specificity of 76.3-91.6%. DATA CONCLUSION Stratifying schemes relying on gadoxetic acid-enhanced MRI provide an additional insight into the presence of preoperative MVI. The Xu model outperformed the other models in terms of accuracy when performed by an experienced radiologist. Conversely, the Lei model outperformed the other models in terms of reproducibility. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:433-447.
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Affiliation(s)
- Shu-Wen Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiu-Ping Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xun Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei-Peng Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhang L, Kuang S, Chen J, Zhang Y, Zhao B, Peng H, Xiao Y, Fowler K, Wang J, Sirlin CB. The Role of Preoperative Dynamic Contrast-enhanced 3.0-T MR Imaging in Predicting Early Recurrence in Patients With Early-Stage Hepatocellular Carcinomas After Curative Resection. Front Oncol 2019; 9:1336. [PMID: 31850221 PMCID: PMC6892896 DOI: 10.3389/fonc.2019.01336] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives: Liver resection is potentially curative for early-stage hepatocellular carcinoma (eHCC) in patients with well-preserved liver function. The prognosis of these patients after resection is still unsatisfactory because of frequent early recurrence (ER). Therefore, we investigated the role of preoperative dynamic contrast-enhanced 3.0-T MR imaging in predicting ER of eHCC after curative resection. Methods From May 2014 to October 2017, we retrospectively analyzed 82 patients with eHCC who underwent dynamic MR imaging and subsequently underwent curative resection. Liver Imaging Reporting and Data System (LI-RADS) v2018 major and ancillary imaging features, as well as two non-LI-RADS MR imaging features (irregular tumor margin and tumor number), were evaluated. A multivariate Cox regression analysis was used to identify independent predictors, and two models (preoperative and postoperative prediction models) were developed. Results ER was observed in 25 patients (25/82, 30.5%). In the univariate analyses, preoperative alpha-fetoprotein (AFP) level >200 ng/ml, three MR imaging features (multifocal tumors, corona enhancement, and irregular tumor margin), and microvascular invasion (MVI) were associated with ER. In the multivariate analysis, corona enhancement (hazard ratio [HR]: 2.970; p = 0.013) and irregular tumor margin (HR: 2.377; p = 0.048) were independent predictors in the preoperative prediction model, and preoperative AFP level >200 ng/ml (HR: 2.493; p = 0.044) plus corona enhancement (HR: 3.046; p = 0.014) were independent predictors in the postoperative prediction model (microvascular invasion [MVI] was not; p = 0.061). When combined with both predictors, the specificity for ER in the preoperative prediction model was 98.2% (56/57), which was comparable to that of the postoperative prediction model [96.7% (55/57)]. Conclusions Our results demonstrated that preoperative MR imaging features (corona enhancement and irregular tumor margin) have the potential to preoperatively identify high-risk ER patients with eHCC, with a specificity >90%.
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Affiliation(s)
- Linqi Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sichi Kuang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingbiao Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Binliang Zhao
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hao Peng
- Department of Nuclear Medicine, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Yuanqiang Xiao
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kathryn Fowler
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, United States
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego, La Jolla, CA, United States
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Tokumitsu Y, Shindo Y, Matsui H, Matsukuma S, Nakajima M, Suzuki N, Takeda S, Wada H, Kobayashi S, Eguchi H, Ueno T, Nagano H. Utility of scoring systems combining the product of tumor number and size with liver function for predicting the prognosis of patients with hepatocellular carcinoma after hepatectomy. Oncol Lett 2019; 18:3903-3913. [PMID: 31516601 DOI: 10.3892/ol.2019.10688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
Our previous study reported the effectiveness of the product of tumor number and size (NxS factor) as a predictor of the prognosis of patients with hepatocellular carcinoma (HCC) following hepatectomy. The aim of the present study was to validate the prognostic value of scoring systems based on the NxS factor for HCC. The records of 940 patients who underwent hepatectomy for HCC at Osaka University Graduate School of Medicine and Osaka International Cancer Institute were analyzed. The discriminatory abilities of the mathematical integrated model for tumor staging (MITS) score, which combines the NxS factor with liver function, and known prognostic systems, including the Japan Integrated Staging system, the Barcelona Clinic Liver Cancer, Cancer of the Liver Italian Program and the Tokyo system, were compared. Firstly, the present study demonstrated that a higher NxS factor was associated with decreased disease-free survival (DFS) and overall survival (OS) in patients with HCC (P<0.05). Subsequently, univariate analysis of DFS and OS curves revealed significant differences among all NxS factor and liver damage combinations (MITS-LD score; score 0 vs. score 1; score 1 vs. score 2; score 2 vs. score 3; all P<0.05) and all NxS factor and albumin-bilirubin (ALBI) score combinations (MITS-ALBI score; score 0 vs. score 1; score 1 vs. score 2; score 2 vs. score 3; all P<0.05). Furthermore, multivariate Cox proportional hazards model analysis demonstrated that there were significant differences in DFS [Hazard Ratio (HR); score 0 vs. score 1 (1.48); score 1 vs. score 2 (1.27); score 2 vs. score 3 (1.64); all P<0.05] and OS [HR; score 0 vs. score 1 (1.34); score 1 vs. score 2 (1.29); score 2 vs. score 3 (1.64); all P<0.05] among patients with different MITS-LD scores, and there were significant differences in DFS [HR; score 0 vs. score 1 (1.38); score 1 vs. score 2 (1.43); score 2 vs. score 3 (1.60); all P<0.05] among patients with different MITS-ALBI scores. The NxS factor may be a comprehensive measure of tumor burden for predicting the prognosis of patients with HCC following liver resection, and MITS scores could be an improved scoring system for predicting the prognosis of patients with HCC after hepatectomy.
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Affiliation(s)
- Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Satoshi Matsukuma
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Masao Nakajima
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
| | - Hiroshi Wada
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Tomio Ueno
- Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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Zhang XP, Zhou TF, Wang ZH, Zhang F, Zhong CQ, Hu YR, Wang K, Chai ZT, Chen ZH, Wu MC, Lau WY, Cheng SQ. Association of Preoperative Hypercoagulability with Poor Prognosis in Hepatocellular Carcinoma Patients with Microvascular Invasion After Liver Resection: A Multicenter Study. Ann Surg Oncol 2019; 26:4117-4125. [DOI: 10.1245/s10434-019-07504-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Indexed: 12/14/2022]
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Ke RS, Cai QC, Chen YT, Lv LZ, Jiang Y. Diagnosis and treatment of microvascular invasion in hepatocellular carcinoma. Eur Surg 2019. [DOI: 10.1007/s10353-019-0573-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Amado V, Rodríguez-Perálvarez M, Ferrín G, De la Mata M. Selecting patients with hepatocellular carcinoma for liver transplantation: incorporating tumor biology criteria. J Hepatocell Carcinoma 2018; 6:1-10. [PMID: 30613572 PMCID: PMC6306074 DOI: 10.2147/jhc.s174549] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation (LT) is the optimal therapeutic option for patients with liver cirrhosis and hepatocellular carcinoma (HCC). Due to universal donor shortage, only the patients with limited tumor burden (under the so-called Milan criteria) are considered as potential candidates for LT in most institutions. It is expected that in the near future, more liver grafts will be available for patients with HCC due to the implementation of new direct antivirals against hepatitis C, leaving a prone scenario to consider expanding Milan criteria. A moderate expansion of Milan criteria could be implemented without increasing the risk of tumor recurrence if patients with favorable biological behavior are carefully selected. Incorporating information regarding tumor biology in the decision-making algorithm would result in a more rational use of LT in patients with HCC. In the present review, surrogate markers of tumor biology are critically evaluated as potential tools to be combined with existing radiological criteria. In addition, the current state of liquid biopsy is discussed, as this cutting-edge technology may reshape the management of HCC in the upcoming years.
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Affiliation(s)
- Víctor Amado
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Gustavo Ferrín
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain,
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